Summer Camp Scholarship Application Form
Child's Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child's School
STEAM Camp Session Dates Requested
June 7th - June 25th (6-8 year olds)
July 12 - July 30th (6-8 year olds)
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Family Information
Guardian 1
Email
example@example.com
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian 2
Email
example@example.com
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other children in family
Configurable list
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Additional Information
Child's Pronouns
She/Her
He/Him
They/Them
Prefer Not To Say
Other
Annual Family Income (Gross)
$
Number of Persons in Household
Notes
Submit
Should be Empty: